{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T08:16:41Z","timestamp":1785572201657,"version":"3.56.0"},"reference-count":38,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Sleep is an important component of human health and can be measured longitudinally using digital activity trackers. Further, decentralized digital research has the potential to provide a real-world picture of sleep in large populations.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study examined whether longitudinal sleep patterns from activity trackers could predict risk of obstructive sleep apnea (OSA) and hypertension, as defined by the Berlin questionnaire and self-report, respectively.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We recruited adults aged \u226518 years nationwide to join our sleep-focused smartphone-based study, called the Research Framework for Exploring Sleep Health. Our sample of 391 adults predominantly comprised women (68%, 247\/364) with a mean age of 48 (SD 13.62) years. Participants were asked to fill out health-related surveys, including the Berlin questionnaire and the Horne-Ostberg questionnaire for chronotype. Participants were asked to link their own activity tracker to the app to collect longitudinal sleep data.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We analyzed sleep data from 391 participants; the cohort was predominantly White (65%, 231\/353) followed by multiracial (17%, 61\/353) and Hispanic or Latino (6.5%, 23\/353) participants. Collinearity testing showed that OSA risk and self-reported hypertension could be considered independently. Holding BMI at a fixed value, the odds of having high OSA risk increased by 159% for every 1-hour increase in weekday sleep variability (odds ratio [OR] 2.592, 95% CI 1.613-4.400;\n P<\/jats:italic>\n <.001), and the odds of high OSA risk increased by 93% for each 1-hour increase in weekend sleep variability (OR 1.928, 95% CI 1.197-3.094;\n P=<\/jats:italic>\n .01). The odds of having high OSA risk increased by 22% for each unit (kg\/m\n 2<\/jats:sup>\n ) increase in BMI, holding both weekday and weekend sleep at separate fixed values (OR 1.217, 95% CI 1.153-1.293;\n P<\/jats:italic>\n <.001). Controlling for age, sex, and BMI, the odds of endorsing hypertension increased by 71% for every 1-hour increase in weekday sleep variability (OR 1.712, 95% CI 1.062-2.917;\n P=<\/jats:italic>\n .03). Conversely, for weekend sleep, the odds of endorsing hypertension increased by 43% for a 1-hour increase in weekend sleep variability (OR 1.432, 95% CI 1.062-1.928;\n P=<\/jats:italic>\n .04). Increased sleep variability predicted a high risk for both OSA and hypertension in this decentralized cohort, when using data from the Berlin questionnaire.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Our study demonstrates the utility of decentralized digital health studies in sleep research. It highlights the potential of activity trackers to predict risk for OSA and hypertension without requiring other patient information or assessment. Sleep variability is gaining increasing importance in the context of sleep health. Digital devices have the potential to help individuals assess their risk for certain disorders.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/77641","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T18:20:06Z","timestamp":1757960406000},"page":"e77641-e77641","source":"Crossref","is-referenced-by-count":1,"title":["Digital Biometrics in Predicting Risk for Obstructive Sleep Apnea and Hypertension: Decentralized, Prospective Cohort Study"],"prefix":"10.2196","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8079-4880","authenticated-orcid":false,"given":"Natalia","family":"Orendain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1274-3736","authenticated-orcid":false,"given":"Samantha Spierling","family":"Bagsic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1675-7094","authenticated-orcid":false,"given":"Edward","family":"Ramos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0119-0881","authenticated-orcid":false,"given":"Jay","family":"Pandit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6515-6204","authenticated-orcid":false,"given":"Robert L","family":"Owens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9098-1724","authenticated-orcid":false,"given":"Stuti","family":"Jaiswal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2021.10.023","article-title":"Sleep-wake misperception: a comprehensive analysis of a large sleep lab cohort","volume":"88","author":"Valko","journal-title":"Sleep Med"},{"issue":"8","key":"R2","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1016\/j.sleep.2008.06.016","article-title":"Sleep perception in insomniacs, sleep-disordered breathing patients, and healthy volunteers--an important biologic parameter of sleep","volume":"10","author":"Pinto","journal-title":"Sleep Med"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2015.06.003","article-title":"Beyond the mean: a systematic review on the correlates of daily intraindividual variability of sleep\/wake patterns","volume":"28","author":"Bei","journal-title":"Sleep Med Rev"},{"issue":"12","key":"R4","doi-asserted-by":"publisher","DOI":"10.3390\/nu13124543","article-title":"Social jetlag and related risks for human health: a timely review","volume":"13","author":"Caliandro","journal-title":"Nutrients"},{"issue":"4","key":"R5","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1080\/07420528.2017.1413578","article-title":"compared with polysomnography in adults","volume":"35","author":"de Zambotti","journal-title":"Chronobiol Int"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-020-00753-2","article-title":"Real-world longitudinal data collected from the SleepHealth mobile app study","volume":"7","author":"Deering","journal-title":"Sci Data"},{"key":"R7","unstructured":"Putilov AA Donskaya OG Verevkin EG Putilov DA Shtrak MB . Chronotype, somnotype and trototype as the predictors of the time course of subjective and objective indexes of sleepiness in sleep deprived subjects. In: Sleep Deprivation: Causes, Effects and Treatment. 2009:95-142. ISBN: 978-1-60741-974-7"},{"issue":"9","key":"R8","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"Peppard","journal-title":"Am J Epidemiol"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.08.010405","article-title":"Association of obstructive sleep apnea with hypertension: a systematic review and meta-analysis","volume":"8","author":"Hou","journal-title":"J Glob Health"},{"issue":"5","key":"R10","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1161\/CIRCOUTCOMES.111.964783","article-title":"Association of obstructive sleep apnea with risk of serious cardiovascular events: a systematic review and meta-analysis","volume":"5","author":"Loke","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"3","key":"R11","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1161\/STROKEAHA.118.023807","article-title":"Sleep-disordered breathing is associated with recurrent ischemic stroke","volume":"50","author":"Brown","journal-title":"Stroke"},{"issue":"2","key":"R12","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s11325-009-0298-7","article-title":"Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death","volume":"14","author":"Shah","journal-title":"Sleep Breath"},{"issue":"12","key":"R13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-013983","article-title":"Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis","volume":"7","author":"Xie","journal-title":"BMJ Open"},{"issue":"3","key":"R14","doi-asserted-by":"publisher","first-page":"427","DOI":"10.5664\/jcsm.6496","article-title":"Using the Berlin questionnaire to predict obstructive sleep apnea in the general population","volume":"13","author":"Tan","journal-title":"J Clin Sleep Med"},{"issue":"4","key":"R15","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/s1389-9457(00)00065-4","article-title":"Validation of the Insomnia Severity Index as an outcome measure for insomnia research","volume":"2","author":"Bastien","journal-title":"Sleep Med"},{"issue":"9","key":"R16","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","journal-title":"J Gen Intern Med"},{"issue":"10","key":"R17","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","journal-title":"Arch Intern Med"},{"issue":"2","key":"R18","first-page":"97","volume":"4","author":"Horne","journal-title":"Int J Chronobiol"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1080\/07420528.2019.1682006","article-title":"Performance assessment of new-generation Fitbit technology in deriving sleep parameters and stages","volume":"37","author":"Haghayegh","journal-title":"Chronobiol Int"},{"issue":"4","key":"R20","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1080\/07420528.2017.1299162","article-title":"Social jet lag: sleep-corrected formula","volume":"34","author":"Jankowski","journal-title":"Chronobiol Int"},{"key":"R21","unstructured":"Fitbit sleep log data export format. MyDataHelps Designer. URL: https:\/\/support.mydatahelps.org\/hc\/en-us\/articles\/360049602813-Fitbit-Sleep-Log-Data-Export-Format [Accessed 13-08-2025]"},{"issue":"2","key":"R22","doi-asserted-by":"publisher","first-page":"175","DOI":"10.3758\/bf03193146","article-title":"G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","journal-title":"Behav Res Methods"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00801-2","article-title":"High night-to-night variability in sleep apnea severity is associated with uncontrolled hypertension","volume":"6","author":"Lechat","journal-title":"NPJ Digit Med"},{"issue":"12","key":"R24","doi-asserted-by":"publisher","first-page":"2621","DOI":"10.1161\/HYPERTENSIONAHA.123.21497","article-title":"Sleep variability, sleep irregularity, and nighttime blood pressure dipping","volume":"80","author":"Xu","journal-title":"Hypertension"},{"issue":"9","key":"R25","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsx109","article-title":"Sleep and physiological dysregulation: a closer look at sleep intraindividual variability","volume":"40","author":"Bei","journal-title":"Sleep"},{"issue":"4","key":"R26","doi-asserted-by":"publisher","first-page":"481","DOI":"10.18865\/ed.31.4.481","article-title":"Diurnal cortisol slope and nighttime blood pressure: a study in European Americans and African Americans","volume":"31","author":"Ernst","journal-title":"Ethn Dis"},{"issue":"7","key":"R27","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1097\/PSY.0000000000000843","article-title":"Intraindividual variability in sleep and levels of systemic inflammation in nurses","volume":"82","author":"Slavish","journal-title":"Psychosom Med"},{"issue":"9","key":"R28","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1097\/PSY.0000000000001130","article-title":"Sleep variability and inflammation in midlife and older women","volume":"84","author":"Leger","journal-title":"Psychosom Med"},{"issue":"9","key":"R29","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1136\/heartjnl-2018-314216","article-title":"Inflammation markers and risk of developing hypertension: a meta-analysis of cohort studies","volume":"105","author":"Jayedi","journal-title":"Heart"},{"issue":"6","key":"R30","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1161\/HYPERTENSIONAHA.123.22714","article-title":"Cytokines, C-reactive protein, and risk of incident hypertension in the REGARDS study","volume":"81","author":"Plante","journal-title":"Hypertension"},{"issue":"12","key":"R31","doi-asserted-by":"publisher","first-page":"1694","DOI":"10.1001\/jamainternmed.2020.2834","article-title":"Association of sleep duration and variability with body mass index: sleep measurements in a large US population of wearable sensor users","volume":"180","author":"Jaiswal","journal-title":"JAMA Intern Med"},{"issue":"9","key":"R32","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1016\/j.jacc.2019.12.054","article-title":"Sleep irregularity and risk of cardiovascular events: the multi-ethnic study of atherosclerosis","volume":"75","author":"Huang","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"R33","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.027361","article-title":"Sleep irregularity and subclinical markers of cardiovascular disease: the multi-ethnic study of atherosclerosis","volume":"12","author":"Full","journal-title":"J Am Heart Assoc"},{"issue":"1","key":"R34","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsad253","article-title":"Sleep regularity is a stronger predictor of mortality risk than sleep duration: a prospective cohort study","volume":"47","author":"Windred","journal-title":"Sleep"},{"issue":"5","key":"R35","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.1161\/CIR.0000000000001078","article-title":"Life\u2019s Essential 8: updating and enhancing the American Heart Association\u2019s construct of cardiovascular health: a presidential advisory from the American Heart Association","volume":"146","author":"Lloyd-Jones","journal-title":"Circulation"},{"issue":"4","key":"R36","doi-asserted-by":"publisher","first-page":"141","DOI":"10.3109\/03091902.2016.1153738","article-title":"Wearable device implications in the healthcare industry","volume":"40","author":"Erdmier","journal-title":"J Med Eng Technol"},{"issue":"6","key":"R37","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.16634","article-title":"Use of wearable devices in individuals with or at risk for cardiovascular disease in the US, 2019 to 2020","volume":"6","author":"Dhingra","journal-title":"JAMA Netw Open"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2022.104696","article-title":"Reporting adherence, validity and physical activity measures of wearable activity trackers in medical research: a systematic review","volume":"160","author":"Chan","journal-title":"Int J Med Inform"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2025\/1\/e77641","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:09:54Z","timestamp":1782842994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2025\/1\/e77641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":38,"URL":"https:\/\/doi.org\/10.2196\/77641","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,3]]},"article-number":"v27i8e77641"}}